双腔起搏器植入后不同右心室心尖部起搏比例对心脏结构功能的远期影响

摘要/Abstract

摘要： 目的：评价双腔起搏器植入后不同右心室心尖部起搏比例对心脏结构和功能的远期影响。方法：入选北京大学第三医院心内科植入双腔起搏器且心室电极置于右心室心尖部的患者，随访并记录末次超声心动图和起搏器程控结果，剔除起搏比例10%~40%的患者。结果：共入选83例患者，随访（38±23）个月。术后中、重度二尖瓣返流（mitral valve regurgitation，MR）和三尖瓣返流（tricuspid valve regurgitation，TR）的发生率均高于术前（6.2% vs. 2.6%，11.1% vs. 4.9%，均P <0.01）。术后中、重度TR患者9例，肺动脉收缩压（pulmonary artery systolic pressure，PASP）高于无或轻度三尖瓣返流患者［(49.6±10.5) mmHg vs. (33.8±12.0) mmHg，1 mmHg=0.133 kPa, P<0.01］，二尖瓣口舒张早期血流速度/二尖瓣外侧环舒张早期速度比值（E/Em）大于其他患者（11±5 vs. 9±3，P<0.05）。心室起搏比例<10%的患者52例（A组），心室起搏比例>40%的患者31例（B组），术后两组中、重度MR和TR的发生率均高于术前。B组术后右心房较术前增大［(17.7±4.0) cm² vs. (15.6±3.2) cm²，P<0.05］，右心室较术前增大［(21.5±4.4) mm vs. (19.9±3.4) mm, P<0.05］，PASP≥50 mmHg的发生率高于术前（9.7% vs. 3.2%，P<0.05）。术后B组左心房、右心房面积均大于A组［(21.8±5.5) cm²vs. (20.2±4.6) cm²，(17.7±4.0) cm² vs. (16.1±3.8) cm²，均P<0.05］，左心室射血分数低于A组（68%±6% vs. 70%±6%，P<0.05）。结论：双腔起搏器植入后过多右心室心尖部起搏远期可导致左心房、右心房和右心室增大，肺动脉高压以及左心室射血分数减低。

关键词: 心律失常, 心脏起搏, 人工, 心室功能, 右, 心房功能, 右

Abstract: Objective：To evaluate long-term effect of different right ventricular apex pacing ratio for heart structure and function of patients with dual chamber pacemakers. Methods: Patients who were implanted with dual chamber pacemakers at Department of Cardiology, Peking University Third Hospital were collected. The electrodes were put in right ventricular apex. All the patients, last pacemaker programming control and echocardiography results were followed up and collected.Patients with 10%-40% pacing ratio were rejected. Results: The total of 83 patients were enrolled in this study. The mean duration of the followup was (38±23) months. The morbility rates of moderate-severe mitral regurgitation (MR) and tricuspid regurgitation (TR) all significantly increased after implantation compared with those before implantation (6.2% vs. 2.6%, 11.1% vs. 4.9%, all P<0.01). There were 9 patients with moderate-severe TR after pacemaker implantation. They had higher pulmonary artery systolic pressure (PASP) and mitral diastolic early flow peak velocity/lateral mitral annulus diastolic early velocity (E/Em) ［(49.6±10.5) mmHg vs. (33.8±12.0) mmHg, P<0.01, 1 mmHg=0.133 kPa; and 11±5 vs.9±3, P<0.05］. And 52 patients had less than 10% pacing ratio (group A) and 31 patients had more than 40% pacing ratio (group B). The right atrium area and right ventricular diastolic diameter were bigger after implantation than those before implantation in group B ［(17.7±4.0) cm² vs. (15.6±3.2) cm², (21.5±4.4) mm vs. (19.9±3.4) mm, all P<0.05］. The morbility of pulmonary artery systolic pressure (PASP) ≥50 mmHg was higher after implantation than that before implantation in group B (9.7% vs. 3.2%, P<0.05). The left atrium area and right atrium area were bigger in group B than those in group A ［(21.8±5.5) cm² vs. (20.2±4.6) cm², (17.7±4.0) cm² vs. (16.1±3.8) cm², all the P<0.05］ after implantation, and lower left ventricular ejection fraction (LVEF) in group B than that in group A (68%±6% vs. 70%±6%, P<0.05). Conclusion: Patients with higher right ventricular apex pacing ratio have bigger left atrium, right atrium and right ventricular, higher PASP and lower LVEF in the long term.

Key words: Arrhythmias, Cardiac pacing, artificial, Ventricular function, right, Atrial function, right

冯杰莉, 张媛, 李昭屏. 双腔起搏器植入后不同右心室心尖部起搏比例对心脏结构功能的远期影响[J]. 北京大学学报（医学版）, 2014, 46(6): 879-882.

FENG Jie-Li, ZHANG Yuan, LI Zhao-Ping. Long-term effect of different right ventricular apex pacing ratio on heart structure and function of patients with dual chamber pacemaker[J]. Journal of Peking University(Health Sciences), 2014, 46(6): 879-882.

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